Healthcare Provider Details

I. General information

NPI: 1841808219
Provider Name (Legal Business Name): SHARONDA S JOHNSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 05/27/2023
Certification Date: 05/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 PROSPECT ST
BLOOMFIELD NJ
07003-3211
US

IV. Provider business mailing address

PO BOX 2270
UNION NJ
07083-2270
US

V. Phone/Fax

Practice location:
  • Phone: 908-655-8524
  • Fax:
Mailing address:
  • Phone: 908-655-8524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00611900
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: